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PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY. I. Bat á r Department of Obstetrics and Gynecology University of Debrecen, Hungary 7th ESC SEMINAR , September 12 - 13, 2003 Budapest, Hungary. SHORT HISTORY OF IUD Cornerstone international and Hungarian events.

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PREVALENCE, AVAILABILITY AND ACCESSABILITY OF IUD IN HUNGARY

I. Batár

Department of Obstetrics and Gynecology

University of Debrecen, Hungary

7th ESC SEMINAR,September 12 - 13, 2003

Budapest, Hungary


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SHORT HISTORY OF IUD

Cornerstone international and Hungarian events

1909 Dr. Richard Richter (Germany): dried silkworm gut

1923 Dr. Karl Pust (Germany): similar device with tail

1929 Dr. Ernst Gräfenberg (Germany): Gräfenberg ring

1934 Dr. T. A. Ota (Japan): Ota ring

1959 Reconsideration of IUD use (Oppenheimer/IL, Ishihama/J)

1960 Dr. Lazar Margulies (USA): Margulies spiral

1962 Dr. Jack Lippes (USA): Lippes loop (Gold Standard!)

1965 Dr. FerencSzontágh (Hungary): Szontágh IUD (plastic)

1972 Szontágh IUDmarketed in Hungary after clinical trials

1074 Limited number of TCu 200 IUD for clinical trials

1970s-1980s Clinical trials with new IUDs in designated centers

1990s Wide range of devices became available in Hungary

I.B. * 7th ESC Seminar, Budapest


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PREVALENCE OF IUD USE IN HUNGARY I.

  • 1970s – 1980s: exact figures (all-country reporting system)

  • 50.000 - 60.000 insertions/year

  • (minus illegal export to Romania?)

  • 1990s – 2000s: no central recording, only estimations

    • Marketing surveys: 35.000-40.000 insertions/year(Schering)

    • Contraceptive survey/demographic data:

      • a) IUD use: 14% ofmarried women in reproductive age

      • b) No of married women in reproductive age (2001): 1.3 M

      • c) Calculated number of users: 177.000

      • d) If changed every 5 (?) years: 35.000 insertions/year (?)

      • (plus non married women)

  • IUD is the second in the rank of methods next to the pill (33%)

I.B. * 7th ESC Seminar, Budapest


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PREVALENCE OF IUD USEWORLDWIDE (1998)*

Country/Region Percentage of women of reproductive age

Contraception total IUD Rank #

Hungary 73 14 2

WORLD 58 13 3

USA (min) 59 1 6

Finland (max) 80 29 2

Moldova (max) 74 38 1

Less developed regions 55 14 2

More developed regions 70 6 5

CEEC 67 16 2

Northern Europe 78 18 3

Western Europe 75 9 3

Southern Europe 68 4 4

* Source: UN

I.B. * 7th ESC Seminar, Budapest


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1. Types of devices

xSzontágh IUD

Nova T

TCu 380

TCu 200

Alloy IUDs:

SilverLily/GoldLily

SilverLily-Zn/Plastic*

Utering

GyneFix

* =available in three sizes

Plastic = no metalcontent

Nova T 380

Mirena

AVAILABILITY OF IUD IN HUNGARY I.

MLCu 250/375

(Mona Lisa)

X= not available anymore (non-medicated)

I.B. * 7th ESC Seminar, Budapest


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AVAILABILITY OF IUD IN HUNGARY II.

  • 2. Where to get it?

    • pharmacies (Mirena is exclusively available here)

    • company sales (directly or through distributors)

    • physician’s office (mainly in private praxis)

  • 3. When to insert?

    • interval (usually on cycle days 1-7)

    • post abortion (not everywhere accepted)

    • post partum (6-8 weeks following delivery)

    • post placental (limited number of cases in clinical trials;

    • no suitable devices are available)

    • post coital (emergency contraception: not well known)

I.B. * 7th ESC Seminar, Budapest


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ACCESSABILITY OF IUD IN HUNGARY I.

  • 1. Legalrestrictions

    • nulligravidas (sometimes neglected)

    • only gynecologists are allowed to insert

    • insertion in centers with lying-in background (?)

    • (nowadays neglected)

I.B. * 7th ESC Seminar, Budapest


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ACCESSABILITY OF IUD IN HUNGARY II.

  • 2. Medical (ob/gyn) limitations

    • „optimal for those with completed family size”

    • „suggested after the second child”

    • side effects/problems are more publicized

    • than benefits

    • not widely known asemergency contraception

I.B. * 7th ESC Seminar, Budapest


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ACCESSABILITY OF IUD IN HUNGARY III.

  • 3. Financial limitations

    • not subsidized by the health insurance

    • (since 1993)

    • high price (compared to salary; the cheapest!)

    • not exempted for VAT (12%  25%!)

    • “punishment” instead of support

    • indirect effect (IUD use has not been a

    • medical indication for abortion since 1993)

I.B. * 7th ESC Seminar, Budapest


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CONCLUSIONS I.

  • Hungary was pioneer for IUD use in the 1960s, and has a good position even nowadays as forinventions (see alloydevices)

  • Prevalence:

  • although acceptable (14%), but it could further be increased througheliminatingordecreasing the restrictive and limiting factors

I.B. * 7th ESC Seminar, Budapest


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CONCLUSIONS II.

  • Availability:

    • market has a wide choice of IUDs, but newtypes are welcomed

    • devices are easy to get(pharmacies, clinics)

    • positive attitude needs to be increased (correct information,postabortal insertion, emergency contraception)

I.B. * 7th ESC Seminar, Budapest


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CONCLUSIONS III.

  • Accessibility:

    • eliminating legal restrictions (gravidity/parity, who/where to insert)

    • decreasing medical barriers through CME

    • modifying health care, social and taxation policy to reduce prices

I.B. * 7th ESC Seminar, Budapest


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